Provider Demographics
NPI:1841479441
Name:EUGENE A CHIAPPETTA MD PA
Entity type:Organization
Organization Name:EUGENE A CHIAPPETTA MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:ACHILLE
Authorized Official - Last Name:CHIAPPETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-751-3555
Mailing Address - Street 1:FIVE FRANKLIN AVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3566
Mailing Address - Country:US
Mailing Address - Phone:973-751-3555
Mailing Address - Fax:973-751-6882
Practice Address - Street 1:FIVE FRANKLIN AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3566
Practice Address - Country:US
Practice Address - Phone:973-751-3555
Practice Address - Fax:973-751-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02084100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1159801Medicaid
NJ788396Medicare PIN
NJD96680Medicare UPIN